Perioral Dermatitis

What is perioral dermatitis?

Perioral dermatitis is a rash that develops around the mouth. The word perioral means 'around the mouth'. Dermatitis means 'inflammation of the skin'.

What is the rash like?

Typically, small red or pink lumpy spots develop on the skin anywhere around the outside of the mouth. That is, it may appear on the chin, cheeks, and the skin next to and below the nose. They look a little like acne spots, but it is not acne. The skin under and next to each lump is often red or pink. It there are a lot of lumps next to each other, then the area of affected skin can just look red and lumpy.

Typically, the skin just next to the lips is not affected, or is affected much less than the skin just a little further away from the lips. So, in some cases, it looks like the rash forms almost a 'ring' around the mouth, but sparing a small border of skin next to the lips. Occasionally, the skin around the eyes is also affected.

The severity of the rash can vary from a few minor spots that are barely noticeable, to a definite and obvious unsightly lumpy rash that is around the mouth. The rash is not usually painful or itchy. However, some people report a mild burning or itchy feeling. The rash is not serious and is not associated with any underlying disease. However, it can be unsightly.

Who gets perioral dermatitis?

Almost all cases occur in young women, most commonly between the ages of 20 and 45 years. It is thought to affect up to 1 in 100 women at some point in their life. It is uncommon in men and children.

What causes perioral dermatitis?

The cause is not clear. However, in many cases the rash seems to be triggered by one or more of the following:

• Steroid creams and ointments are a main trigger. See below for details.
• Make up, cream cleansers and cosmetics applied to the area affected on the face. It may be that certain ingredients of creams and cosmetics may be the trigger. For example, one study found that make up foundation seemed to be a particular provoking factor.
• Physical factors such as strong winds and UV light.
• Fluorinated toothpaste has been suggested as a possible trigger.
• Yeasts and bacteria that live in hair follicles have been suggested as a possible trigger (although perioral dermatitis is not just a simple skin infection).
• Hormone factors may play a part as some women find that the rash becomes worse just before a period.
• The oral contraceptive pill may be a factor in some cases.

Perioral dermatitis and steroid creams and ointments
There is a well known link between using a topical steroid (steroid creams, gels, ointments etc) and developing perioral dermatitis. Many cases develop soon after using a topical steroid on the face for another condition such as mild eczema. You may even rub some steroid on your face without realising if you are treating another part of your body with a topical steroid. For example, you may scratch the treated area of your skins (say, your elbow, for example), and then rub the finger onto your face without realising.

Topical steroids can also temporarily clear a mild patch of perioral dermatitis. Some people will have tried a steroid cream that you can buy at pharmacies to treat what they think is mild eczema. However, as soon as the rash clears, and you stop the steroid, the rash re-appears, only even worse. This can get into a vicious circle as you may then put more steroid cream on to clear the reappearance of the rash, which may clear. Again, you may then stop the treatment, but then the rash comes back again even worse. Etc.

What is the treatment for perioral dermatitis?

Without treatment, the condition may last months or years. Treatment can usually help.

Firstly, your doctor is likely to advise that you stop using any cream, ointment, cosmetics, etc, on your face, In particular, to stop using any topical steroid. If you have been using a topical steroid, the rash will get worse for several days before it gets any better. You may have to anticipate and accept this. Just wash your face with water only whilst the rash is present. Some doctors advise not to use toothpaste that contains fluoride.

Even when the rash has gone, it is best to not use any cosmetics or creams on the affected area as the rash may re-appear. And use only a bland liquid face cleaner to wash your face rather than bar soap.

Antibiotics
Your doctor may prescribe an antibiotic tablet in the tetracycline group. Topical antibiotics are sometimes used in milder cases. The course of treatment is usually 6-12 weeks and you may not notice any improvement for the first few weeks whilst taking treatment. However, there is an improvement in most cases within two months after starting antibiotic treatment. So, do persevere if an antibiotic is prescribed. The way antibiotics work in this condition is not clear. It is not a simple skin infection. However, tetracyclines and some other antibiotics have an action to reduce inflammation in addition to killing bacteria, and this may be why they work.

References

1. Hans J Kammler Perioral Dermatitis Emedicine Article dated July 25, 2006
2. Perioral dermatitis PatientPlus Article dated 15 Aug 2005
3. Malik R, Quirk CJ Topical applications and perioral dermatitis. Australas J Dermatol. 2000 Feb;41(1):34-8.

See www.patient.co.uk/showdoc/1097/ for links to websites showing pictures of skin conditions.

© EMIS and PIP 2007   Updated: February 2007